Fig 2. Histopathological findings observed in pulmonary muscular
arteries showed variable degrees of arterial media and intima
remodeling. (A) Intima (triangles) and media (arrowheads) thickening,
hyaline membranes were observed within alveolar septa (hematoxylin and
eosin [HE], × 100)). (B) media layer (arrowheads) thickening (HE,
×100). (C) media layer (arrowheads) thickening and diffuse hyaline
membrane formation(arrows) in the alveolar space were observed (HE,
×100). (D&E) minor thickening of muscular pulmonary arteries(HHF 35,
×100) (F) media (arrowheads) thickening (HE ×200).
As for cardiac pathological changes, the volume of heart was larger, no
significant abnormalities were observed in the exiting or entering great
vessels of the heart. All the cases had large PDA and PFO, with a mean
diameter of DA 4.6 mm. The
average wall thickness of RV was 2.6 mm. Microscopic examination showed
turbid swelling of muscle fibers and lytic degeneration of some muscle
fibers. There were no significant inflammatory cell infiltration and
myocardial cell necrosis. No epicardial changes were observed.
From the hepatic findings, 7 cases showed herniation, liver
abnormalities were observed in the unoperated group, significant
impression was observed in the herniated part of the liver tissue, and
the liver texture was slightly solid. Marked congestion was noted.
Microscopic observation showed that normal structure of hepatic lobule
was present, and hepatocytes were obviously swollen and degenerated. The
sinusoids were markedly dilated and congested with bleeding in some
areas. Marked extramedullary hematopoiesis was seen. Focal inflammatory
cell infiltration was observed in the portal area, with significant
dilatation and congestion of small vessels.
The structure of the diaphragm was absent in the ipsilateral side, while
muscle fiber tissues in contralateral side were normal. Striated muscle
tissue was still observed in the periphery of defect side. Diaphragm
separated by delicate fibrovascular connective tissue either devoid of
muscle or with only a few skeletal muscle fibers present in congenital
eventration (Fig 1 H). Focal chronic inflammatory cell infiltration was
found in operated cases and one of them had significant dilated
congestion and calcification necrosis (Fig 1 I).
Two patients had accessory splenic malformation, one had thymic
dysplasia and the others showed no significant abnormalities.
Table 2. Histological findings in patients who died from CDH